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$124.95
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#29357
(ISBN 978-1-932529-35-7)
664 pages
7" x 10" hardcover
© 2008
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Managing
Health Services Organizations and Systems, Fifth Edition
By Beaufort B.
Longest, Jr., Ph.D., FACHE, and Kurt Darr, J.D., Sc.D., FACHE |
About the Authors
Preface
Acknowledgments
Acronyms Used in Text
Part I: The Healthcare Setting
- Healthcare in the United States
- Health and System Goals
- Lack of Synchrony
- Processes that Produce Health Policy
- Public Processes
- Judicial Process
- Executive Orders
- Private Processes
- A Brief History of Health Services in the United
States
- Technology
- Mortality and Morbidity
- Social Welfare
- Federal Initiatives
- Other Western Systems
- Structure of the Health Services System
- Classification and Types of HSOs
- Profit or Not for Profit
- Ownership
- Length of Patient Stay
- Role in the Health Services System
- Unique Institutional Providers
- Mental Health Organizations
- Teaching Hospitals
- Local, State, and Federal Regulation of Health
Service Organizations and Systems
- Licensure and Regulation
- Conditions of Participation
- Planning and Rate Regulation
- UR, PSROs, and PROs
- Other Regulators of Health Services Organizations
and Systems
- Accreditation in Health Care
- Accreditors of HSOs/Hss
- Educational Accreditors
- Education and Regulation of Health Services
Managers
- Health Services Workers
- Physicians
- Nonphysician Clinicians
- Regulation and Education of Selected Health
Occupations
- Licensure, Certification, and Registration
- Education of Clinicians
- Associations for Individuals and Organizations
- Professional Associations for Individuals
- Associations for Health Service Organizations
and Systems
- Paying for Health Services
- Expenditure Trends
- Sources and Uses of Funds in Healthcare
- Private Payment Under the Insurance Principle
- Government Payment Schemes
- Background
- Diagnosis-Related Groups
- Resource Utilization Groups
- Ambulatory Patient Groups and Ambulatory
Payment Categories
- Resource-Based Relative Value Scale
- Summary
- System Trends
- Discussion Questions
- Case Study 1: Gourmand and Food—A Fable
- Case Study 2: Where's My Organ?
- Case Study 3: Dental Van Shenanigans
- Notes
- Types and Structures of Health Services Organizations
and Health Systems
- The Triad of Key Organizational Components
- Governing Body
- Chief Executive Officer
- Professional Staff Organization
- Governing Body
- Responsibilities and Functions
- Composition
- Committees
- Relationship to the CEO
- Chief Executive Officer
- CEO Responsibilities and Required Skills
and Knowledge (Competencies)
- Professional Staff Organization
- Integrating LIPs into Management
- Self-Governance
- Open or Closed
- Committees
- Clinical Departmentation
- Credentialing
- PSO Membership
- Clinical Privileges
- PSO Disciplinary Action
- Organizational Structures of Selected HSOs/HSs
- Acute Care Hospitals
- Hospitals by the Numbers
- Organizational Structure of Acute Care Hospitals
- Nursing Facilities
- Organization Structure of Nursing Facilities
- Health Systems
- The Triad in Health Services Systems
- CEOs
- Governing Bodies
- Professional Staff Organizations
- Ambulatory Health Services
- Hospice
- Organizational Models and Structures
- Home Health Agencies
- Organizational Structures of HHAs
- Managed Care
- Types of MCOs
- Organizational Structures of MCOs
- Public Health
- The Ongoing Phenomenon of Corporate Diversification
of Health Service Organizations and Systems
- Environmental Pressures to Change Types and
Structures of Health Service Organizations
and Systems
- Discussion Questions
- Case Study 1: The Clinical Staff
- Case Study 2: Role of the Healthcare Executive
in a Change in Organizational Ownership or Control
- Case Study 3: Public Health and the Health Services
Delivery Systems
- Case Study 4: Board
Effectiveness
- Notes
- Healthcare Technology
- History and Background
- Types of Technologies
- Definitive (Curative, Preventive) Technologies
- Halfway (Add-On) Technologies
- Deferral Technologies
- Competing Technologies
- Cost-Saving Technologies
- Effects of Technology on Health Status
- Forces Affecting Development and Diffusion of
Technology
- Medical Education and Medical Practice
- Third-Party Reimbursement of Services
- Diagnosis-Related Groups
- Centers for Medicare and Medicaid Services
- The Public
- Competitive Environment
- Responses to Diffusion and Use of Technology
- PSROs, PROs, and QIOs
- Private
Sector Activities
- Healthcare Technology Assessment
- Public Sector Activities
- Private Sector Activities
- Summary
- HSO/HD Technology Decision Making
- Review and Planning
- Financing Technology
- Evaluating and Acquiring Technology—TEAM
- Newer Alternative to TEAM
- Summary
- Managing Biomedical Equipment in HSOs/HSs
- Systems Engineering
- Organization
- Health Information Technology
- Regional Health Information Organizations
- RHIOs — Case Examples
- Problems of Implementing RHIOs
- Enterprise-Level EHRs
- Advantages of EHRs
- Disadvantages of EHRs
- Summary
- Telemedicine
- Future Developments
- Biomedical Equipment
- Clinical Support and Information Systems
- Technology and the Future of Medicine
- Discussion Questions
- Case Study 1: The Feasibility of BEAM
- Case Study 2: "Who Does What?"
- Case Study 3: "Let's Do a Joint Venture"
- Case Study 4: Worst Case Scenario — The
Nightmare
- Notes
- Ethical and Legal Environment
- Society and the Law
- Relationship of Law to Ethics
- Ethics Framework
- Moral Philosophies
- Linking Theory and Action
- Summary
- Personal Ethic and Professional Codes
- Health Service Codes of Ethics
- Managers
- Clinicians
- Institutional Trade Associations
- Bills of Rights
- Ethical Issues Affecting Governance and Management
- Fiduciary Duty
- Conflicts of Interest
- Ethics and Marketing
- Biomedical Ethical Issues
- Resource Allocation
- Consent
- End-Of-Life Decisions
- Life Sustaining Treatment
- Advance Medical Directives
- Euthanasia
- Physician-Assisted Suicide
- Futile Treatment
- Organizational Response to Ethical Problems
- Means to Resolve Ethics Issues
- Managers and the Law
- Torts
- Torts and HSOs/HSs
- Agency and Corporate Liability
- Enterprise Liability
- Reforms of the Malpractice System
- Nonjudicial Means of Resolving Disputes
- Selected Legal Areas Affecting HSOs/HSs
- Peer Review
- Emergency Medical Treatment and Active Labor
Act
- Medicare and Medicaid Fraud and Abuse
- Healthcare Integrity and Protection Data
Bank
- Qui Tam Actions
- Tax-Exempt Status of HSOs/HSs
- Telemedicine
- Legal Process of a Civil Lawsuit
- Special Considerations for the Manager
- Record Keeping
- Effective Use of Retainer and House Counsel
- Testifying
- Discussion Questions
- Case Study 1: "What's a Manager to Do?"
- Case Study 2: Bits and Pieces
- Case Study 3: Understanding
- Case Study 4: Allocation
- Notes
Part II:
Managing Health Services Organizations and Systems
- The Practice of Management in Health Services
Organizations and Health Systems
- Key Definitions
- Health Services
- Health Services Organizations (HSOs)
- Health Systems (HSs)
- Managers
- Management
- Management and Organizational Culture, Philosophy
and Performance
- Management and Organizational Culture and
Philosophy
- Management and Organizational Performance
- Management Functions, Skills, Roles, and Competencies
- Management Functions
- Management Skills
- Management Roles
- Management Competencies
- Summary of Approaches to Considering Management
Work
- A Management Model for HSOs/HSs
- Inputs (Resources)
- Outputs (Missions and Objectives)
- Conversion (Integration)
- Managers Managing
- External Environment (An Open Systems Perspective)
- The Challenges of Management
- Looking Forward
- Discussion Questions
- Case Study 1: The CEO's Day
- Case Study 2: Projection of Registered Nurse
Shortage
- Case Study 3: Healthcare Executives' Responsibility
to Their Communities
- Case Study 4: The Business Office
- Notes
- Managerial Problem Solving and Decision Making
- Problem Analysis and Decision Making
- Problem-Solving
- Process and Model
- Conditions that Initiate Problem Solving
- Problem-Solving Activities
- Problem Analysis [1]
- Facts and Reasoning
- Developing Assumptions [2]
- Identifying Tentative Alternative Solutions
[3]
- Developing and Applying Decision Criteria
[4]
- Selecting, Implementing, and Evaluating
the Alternative Solution[5,6,7]
- Implications for the Health Services Manager
- Influencing Problem Solving and Decision Making
- Problem-Solver Attributes
- The Situation
- The Environment
- Implications for the Health Services Manager
- Unilateral and Group Problem Solving
- Group Problem-Solving and Quality Improvement
Techniques
- Problem-Solving and Decision-Making Styles
- Involving Others--A Conceptual Model
- Situational Variable (Problem Attributes)
- Situations and Styles
- Using the Model
- Implications for the Health Services Manager
- Discussion Questions
- Case Study 1: The Nursing Assistant
- Case Study 2: The New Charge Nurse
- Case Study 3: Listening
- Case Study 4: Ping-Pong
- Notes
- The Quality Imperative
- Background
- Quality--Two Dimensions
- Taking a CQI Approach
- CQI, Productivity Improvement, and Competitive
Position
- Theory of CQI
- The Pioneers
- The Builders
- Statistical Process Control
- Process Improvement Models
- Organizing for Improvement
- Role of Governance and Senior Managers
- Quality Improvement Council
- Quality Improvement Teams
- Undertaking Process Improvement
- Other Improvement Methodologies
- Lean and Six Sigma
- ISO 9000 and ISO 14000
- Reengineering
- Facilitators and Barriers to Improvement
- Improvement and Problem Solving
- Tools for Improvement
- Control Charts
- Fishbone or Ishikawa Diagram
- Pareto Analysis
- Scatter Diagrams
- Failure Mode Effects Analysis
- Crew Resource Management
- Benchmarking
- Productivity and Productivity Improvement
- CQI and PI
- Work Systems and Job Design
- Capacity Planning and Facilities Layout
- Production Control, Scheduling, and Supply
Chain
- Strategic Quality Planning: Hoshin Planning
- Customers and Focus
- Align the Organization
- Implement the Plan and Review and Improve
- Physicians and CQI
- Practice Guidelines
- Involving Physicians
- Results of Involving Physicians
- CQI--The Next Iteration
- Discussion Questions
- Case Study 1: Fed Up in Dallas
- Case Study 2: The Carbondale Clinic
- Case Study 3: Noninvasive Cardiovascular Laboratory
- Case Study 4: Clinics
- Notes
- Strategizing
- Strategizing and Systems Theory
- Core Concepts of Systems Theory Environmental
Forces in an Open Society
- Strategizing and Planning
- Planning and the Management Model
- HSO/HS Planning Context
- The Strategizing Process
- Situational Analysis
- External Environmental Analysis
- Scanning
- Monitoring
- Forecasting
- Assessing
- Using and Diffusing Information from Analysis
- Internal Environmental Analysis
- Strategy Formulation
- Common Strategies
- Specialization/Niche Strategies
- Vertical Integration as a Strategy
- Horizontal Integration as a Strategy
- Diversification as a Strategy
- Retrenchment/Divestiture as a Strategy
- Strategic Alliances as a Strategy
- Selecting Strategies
- Strategy Choice
- Strategic Implementation
- Strategic Control
- Strategic Control Systems
- Mechanisms of Strategic Control
- Strategic Issues Management
- Discussion Questions
- Case Study 1: No Time for Strategizing
- Case Study 2: A Response to Change
- Case Study 3: HSO Strategic Assessment
- Case Study 4: Closing Pediatrics
- Case Study 5: Affiliation
- Notes
- Marketing
- Marketing Defined
- Social Marketing Defined
- What Marketing is Not
- What Marketing Is
- Strategic Marketing Management and Analysis
- The Marketing Mix: Core Concepts in Marketing
Management
- Product/Service
- Place
- Price
- Promotion
- The Marketing Mix is Not Carved in Stone
- Challenges in Identifying the Customer and Target
(Desirable) Markets
- Segmenting Markets
- Quantifying Patient/Customer Target Markets
- Examples of Marketing Strategies
- Miles and Snow Typology
- Porter's Competitive Strategies
- Other Prototypical Marketing Strategies
- Industry Structure and Competitive Position:
Porter's Model
- Intensity of Competition (Rivalry)
- Substitute Products
- Potential for New Entrants
- Bargaining Power of Buyers
- Bargaining Power of Suppliers
- Market Position Analysis
- BCG Matrix
- GE (General Electricity) McKinsey/Matrix
- Strategic Marketing Postures
- Market Research
- Ethics in Marketing
- Discussion Questions
- Case Study 1: Lactation Services at Women's
Wellness Hospital
- Case Study 2: What Is Marketing?
- Cast Study 3: Marketing Turmoil--Pharmaceuticals
- Case Study 4: Hospital Marketing Effectiveness
Rating Instrument
- Notes
- Controlling and Allocating Resources
- Monitoring (Control) and Intervention Points
- Output Control
- Process Control
- Input Control
- Control Model
- In Control Loop
- Acceptance Control Loop
- Required Change Control Loop
- Positive Control Loop
- Levels of Control
- Control and CQI
- Control and Problem Solving
- Control Considerations
- Managerial Considerations
- Design Considerations
- Information Systems and Control
- Information Systems: LANs and WANs
- Management and Clinical IS
- Electronic Health Records
- IS Issues
- IS Uses
- Control and Human Resources
- Human Resources Management
- Staffing Activities
- Acquiring Human Resources
- Retaining Employees
- Separation from Employment (Exit)
- Human Resources Department and Clinical Staff
- Human Resources in HSs
- RM and Quality Improvement
- Risk Management
- Improving Quality and Performance
- Summary
- Control Methods
- Budgeting
- Cost Allocation
- Activity-Based Costing
- Financial Statements
- Ratio Analysis
- Operational-Activity Analysis
- Data Analysis Services
- Benchmarking
- Financial Analysis
- Use of Analytical Techniques in Resource Allocation
- Volume Analysis with Revenue
- Volume Analysis without Revenue
- Capital Budgeting
- Cost-Benefit Analysis
- Simulation
- Discussion Questions
- Case Study 1: Admitting Department
- Case Study 2: Centralized Photocopying
- Case Study 3: Barriers to an Effective QI Effort
- Case Study 4: State Allocation Decisions--Centralize
or Decentralize
- Case Study 5: Financial Ratios
- Notes
- Designing
- The Ubiquity of Designing
- Formal and Informal Aspects of Organization
Design
- Classical Design Concepts in Building Organization
Structures
- Weber's Contribution to Organization
Design: Bureaucracy
- Division of Work
- Authority and Responsibility Relationships
- Departmentation
- Span of Control
- Coordination
- Contemporary View
- Mechanisms of Coordination
- Application of the Classical Organization Designing
Concepts
- Designing Interorganizational Relationships
(IORs)
- Strategic Alliances (SAs)
- SAs Categorized by Participants
- SAs Categorized by Purpose
- SAs as Categorized by Form
- An Integrated Perspective on Organization Design
- Five Basic Organization Designs
- Choosing an Organization Design
- Discussion Questions
- Case Study 1: Is the Matrix the Problem or the
Solution?
- Case Study 2: Trouble in the Copy Center
- Case Study 3: "I Cannot Do It All!"
- Case Study 4: Somebody Has To Be Let Go
- Notes
- Leading
- Leading Defined and Modeled
- Power and Influence in Leading
- Sources of Power
- Effective Uses of Power
- Motivation Defined and Modeled
- Conclusions about the Roles of Power and Influence
and of Motivation in Leading
- Approaches to Understanding Leadership
- Leader Traits and Skills
- Leader Behaviors and Styles of Leading
- Situational or Contingency Models of Leading
- Toward an Integrative Approach to Effective
Leading
- Discussion Questions
- Case Study 1: Leadership on the West Wing
- Case Study 2: Charlotte Cook's Problem
- Case Study 3: The Presidential Search
- Case Study 4: The Young Associate's Dilemma
- Notes
- Communication
- Communicating is Key to Effective Stakeholder
Relations
- Communication Process Model
- Senders and Receivers
- Channels of Communication
- Messages Encoded and Decoded
- Barriers to Effective Communication
- Environmental (or contextual) Barriers
- Personal Barriers
- Managing Barriers to Effective Communication
- Flows of Intraorganizational Communication
- Downward Flow
- Upward Flow
- Horizontal and Diagonal Flows
- Communication Networks
- Informal Communication
- Communicating with External Stakeholders
- Listening to External Stakeholders
- Special Circumstances in Communicating with
Certain External Stakeholders
- Communicating in Marketing
- Communicating with the Community or Service
Area
- Communicating with the Public Sector
- Communicating When Things Go Badly
- Discussion Questions
- Case Study 1: Apple Orchard Assisted Living
- Case Study 2: Information Technologies in Rural
Florida Hospitals
- Case Study 3: "You Didn't Tell Me!"
- Case Study 4: How Much Should We Say?
- Discussion Questions
- Notes
Author Index
Subject Index
© 2009-2010 Health Professions Press
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